Inevitably, there will come a time in our medical journeys where we will have to have a difficult conversation with a family about the passing of a loved one. Sometimes, it will be an expected event after a patient has dealt with a long illness at an advanced age; other times, it will be an unexpected event in a person who looked healthy a short time before. These events can ...

Read more...

Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness. When you ask patients what quality is most important in a ...

Read more...

To improve patient care, doctors rely on research and published information. According to an American Medical News report, professional journals are still the most popular source of up-to-date medical information among doctors. These medical publications inform physicians on new drugs and treatments, and they contain peer-reviewed studies that both physicians and patients assume are scientifically accurate. But all too often, research findings aren’t as scientific as they should be. And some are flat-out ...

Read more...

I am a great supporter of mental health research but worry that it has lost its sense of proportion and is chasing the wrong priorities. The really glamorous stuff consumes almost all of the enormous NIMH budget and now has behind it the huge addition of a $650-million private donation aimed at solving the genetics of mental illness. Neuroscience is an extremely easy sell to Congress and rich philanthropists because it promises ...

Read more...

I have never experienced a military boot camp.  I have however completed a rather intense three-year residency in internal medicine followed by another grueling, three-year fellowship in pulmonary and critical care medicine.  I like to think that my experiences were not unlike those of military training. As a matter of fact, being on the medical wards at the county hospital was referred to as being, “in the trenches.”  It was true.  ...

Read more...

In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray. The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.” Many radiologists will sympathize with both the patient who ...

Read more...

In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient's property and are used for a ...

Read more...

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform. I’m not suggesting that an unwelcome ...

Read more...

It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has ...

Read more...

Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These  metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often ...

Read more...